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Inducing Labor When the Bag of Water Breaks, And Thoughts on the Bradley Method

Posted May 15 2009 10:34pm

I cover a lot with my doula clients in the "client interview" process, but I am no substitute for a good childbirth education class when it comes to first-time moms.  I must admit that given my meditative background, I have a fondness for Birthing From Within  classes, but after a couple of births where mom planned to have a natural childbirth but ended up with exactly the opposite due to hospital protocols (the particular protocol being mom must be in active labor 12-24 hours after water breaking), I've decided I need to sit in on a Bradley  class asap and learn more about this method.  From the book, it seems like the Bradley method is very clear about the strong chance of an unnecessary cesarean when delivering at a hospital.  Since I had two births in a row where the mom had a cesarean because of hospital protocols, I feel that a class that really goes over this piece with moms and their partners is priceless.  Maybe first-time moms planning a hospital birth need to take two childbirth classes.  One class could prepare mom find their inner strength and cope with the pain of labor and another that really tells it like it is when it comes to hospital birth and teaches you how to up your chances of normal birth in the hospital.  Or maybe (my ideal) a yoga class that helps you find your birthing power and a class that TRULY prepares you for hospital birth.

I've been wanted to do a post on premature rupture of membranes (PROM) for a while, so let's see what the Bradley Book has to say about inducing labor when the bag of water breaks:

One doctor reporting on a study involving women with ruptured membranes tells us that mere time passing is not related to infection rates.  As a result of his study, he tells us 'there would appear to be no real basis for the stimulation of labor in patients with premature ruptures of the membrane, especially before thirty-two weeks of gestation, since the risk of inection was unrelated to the duration of membrane rupture.'

He goes on to state that only a "hands-off" policy will reduce the chances of infection.1

The author goes on to say :

Three women in my last class of ten couples started with the water bag breaking.  One of these... birthed within or at forty-eight hours, and two birthed one week later.  All of them received good advice from their birth attendant.  They were told not to put anything whatsoever in the vagina.... and were asked to take their temperature regularly and report immediately if there was any rise in temperature.  There were no infections.  There were also no vaginal exams.2


Sadly, this was not the advice given to my moms who were induced.  

And from Varney's Midwifery "

The incidence of chorioamnionitis...increases in direct relationship to the number of pelvic exams performed.... an initial digital examination to determine cervical dilation is unnecessary, since knowledge of cervical findings is superfluous to the management".3

Hmm, so why are care providers so quick to get their fingers in there?????

I would like to point out that the risk of infection (the type of infection we are speaking about when waters break before labor are amnionitis and chorioamnionitis ) is HIGH with cesarean section 4 (along with a whole lot of other risks) a nd that your chances of cesarean are significantly increased with induction

Moms, in order to birth with empowerment, you have a LOT of work to do, especially if you are birthing in a hospital.  Please seriously consider scenarios, such as water breaking before labor starts, early in pregnancy.  How will your care provider handle this scenario?  Please understand that your care giver's actions may be motivated by hospital policy rather then by what is best for mom and baby.  It can be so hard to remain steadfast in your trust of birth, especially as a first time mom birthing in the U.S. (I know, I had a cesarean the first time around) but gather the resources and give it your all! 

1 Susan McCutcheon, Natural Childbirth the Bradley Way (New York: Penguin Books, 1996), 220.
2 Ibid
3 Helen Varney, Jan Kriebs, Carolyn L. Gegor, Varney's Midwifery (Boston: Jones and Bartlett Publishers, 2004) 867.
4 Maternity Center Association, What Every Pregnant Woman Needs to Know About Cesarean Section (New York: The Maternity Center Association) 2004.  Available online,  http://www.childbirthconnection.org/article.asp?ck=10164.
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